When I first became a pediatric PT we talked about primitive postural reflexes as part of the development of postural control. We certainly didn't have all the answers and there were many different perspectives, so these were lively conversations with lots of good clinical problem solving. But references to primitive reflexes had mostly disappeared from the discourse on postural control until fairly recently.
We used to think of development as a hierarchical process. But as our understanding of how the brain works has improved, we now understand it as a complex, dynamic, multi-systems process. So rather than primitive reflexes, I prefer to use the term developmental reflexes - stereotypical movement patterns triggered in response to a sensory stimulus representing our first developmental experiences with registering and responding to our position in space. Babies experience extension and flexion of their body (Moro), their relationship to the support surface (TLR), differentiation of left and right sides of their body (ATNR) as well as the dissociation of their upper body from their lower body (STNR) – all with reference to their head position. As such, they lay down the early sensory and motor neurological wiring which supports the development of mature postural control. And even when mature postural control is present, if the system is stressed or damaged, these patterns reappear to help out with stability. One has only to watch me try to ski a beginner's hill to view a classic ATNR!
Regardless of their usefulness, many clinicians and the literature 1-3 tend to agree that their continued presence in everyday activities is an indicator of postural control difficulty. We also understand that they can interfere with functional skill development. This leads us to the next question - how might we address them in treatment?
My preference is to work from the inside out in building a clinically relevant understanding of the sensorimotor development of postural control. Early postural control is characterized by developmental reflexes, while mature postural control is characterized by both anticipatory and reactive components. Recent research has yielded some exciting information regarding the organization of central stability, alignment, pressures, recruitment of inner core muscles and activation of outer core muscle groups in different client populations. We can leverage this new information in treatment of children with sensory and motor challenges, as we build and blend these developmental reflexes into more mature postural control, which ultimately serves to support complex motor, perceptual and emotional regulation skills.
These new conversations have raised more questions and I'm excited once again by discussions that are filled with new research, clinical observations and problem solving. Please join me for a 2-day adventure as we explore the theory, practical applications and treatment strategies regarding developmental reflexes in Function From the Inside Out: Sensory and Motor Processing for Postural Control as part of the RAIR Symposium in Bloomington MN Feb 26-27, 2016.
1. Sohn M, Ahn Y, Lee S. Assessment of primitive reflexes in high-risk newborns. J Clin Med Res. 2011; 3(6): 285-90.
2. Tribucci AT, Penedo-Leme S, Funayama CAR. Postural adjustment as a sign of attention in 7-month-old infants. Brain Dev. 2009; 31: 300-6.
3. Konicoarova J, Bob P. Asymmetric tonic neck reflex and symptoms of attention deficit and hyperactivity disorder in children. Int J Neurosci. 2013; DOI: 10.3109/00207454.2013.801471.
photo credit leader.pubs.asha.org